Exercise oscillatory ventilation in chronic heart failure has been suggested as a factor related to adverse cardiac events, aggravated prognosis and higher mortality. Exercise training is well known to affect exercise capacity and mechanisms of pathophysiology beneficially in chronic heart failure. Little is known, however, about the exercise training effects on characteristics of exercise oscillatory ventilation in chronic heart failure patients.
Design and methods
Twenty (out of 38) stable chronic heart failure patients exhibited exercise oscillatory ventilation (age 54 ± 11 years, peak oxygen uptake 15.0 ± 5.0 ml/kg per minute). Patients attended 36 sessions of high intensity interval exercise. All patients underwent cardiopulmonary exercise testing before and after the programme. Assessment of exercise oscillatory ventilation was based on the amplitude of cyclic fluctuations in breathing during rest and exercise. All values are mean ± SD.
Results
Exercise training reduced (P < 0.05) the percentage of exercise oscillatory ventilation duration (79.0 ± 13.0 to 50.0 ± 25.0%), while average amplitude (5.2 ± 2.0 to 4.9 ± 1.6 L/minute) and length (44.0 ± 10.9 to 41.0 ± 6.7 seconds) did not change (P > 0.05). Exercise oscillatory ventilation patients also increased exercise capacity (P < 0.05).
Conclusions
A rehabilitation programme based on high intensity interval training improved exercise oscillatory ventilation observed in chronic heart failure patients, as well as cardiopulmonary efficiency and functional capacity.
MurphyRMShahRVMalhotraR. Exercise oscillatory ventilation in systolic heart failure: an indicator of impaired hemodynamic response to exercise. Circulation2011; 124: 1442–1451.
3.
CahalinLPChasePArenaR. A meta-analysis of the prognostic significance of cardiopulmonary exercise testing in patients with heart failure. Heart Fail Rev2013; 18: 79–94.
4.
FlegJLCooperLSBorlaugBA. Exercise training as therapy for heart failure: current status and future directions. Circ Heart Fail2015; 8: 209–220.
5.
BouchlaAKaratzanosEDimopoulosS. The addition of strength training to aerobic interval training: effects on muscle strength and body composition in CHF patients. J Cardiopulm Rehabil Prev2011; 31: 47–51.
6.
Dall’AgoPChiappaGRGuthsH. Inspiratory muscle training in patients with heart failure and inspiratory muscle weakness: a randomized trial. J Am Coll Cardiol2006; 47: 757–763.
7.
WisloffUStoylenALoennechenJP. Superior cardiovascular effect of aerobic interval training versus moderate continuous training in heart failure patients: a randomized study. Circulation2007; 115: 3086–3094.
8.
GerovasiliVDrakosSKravariM. Physical exercise improves the peripheral microcirculation of patients with chronic heart failure. J Cardiopulm Rehabil Prev2009; 29: 385–391.
9.
AnagnostakouVChatzimichailKDimopoulosS. Effects of interval cycle training with or without strength training on vascular reactivity in heart failure patients. J Card Fail2011; 17: 585–591.
10.
SandriMViehmannMAdamsV. Chronic heart failure and aging – effects of exercise training on endothelial function and mechanisms of endothelial regeneration: results from the Leipzig Exercise Intervention in Chronic heart failure and Aging (LEICA) study. Eur J Prev Cardiol2016; 23: 349–358.
11.
DimopoulosSAnastasiou-NanaMSakellariouD. Effects of exercise rehabilitation program on heart rate recovery in patients with chronic heart failure. Eur J Cardiovasc Prev Rehabil2006; 13: 67–73.
12.
Antunes-Correa LM, Ueno-Pardi LM, Trevizan PF, et al. The influence of aetiology on the benefits of exercise training in patients with heart failure. Eur J Prev Cardiol 2017; 24: 365–372.
13.
TasoulisAPapazachouODimopoulosS. Effects of interval exercise training on respiratory drive in patients with chronic heart failure. Respir Med2010; 104: 1557–1565.
14.
GeorgantasADimopoulosSTasoulisA. Beneficial effects of combined exercise training on early recovery cardiopulmonary exercise testing indices in patients with chronic heart failure. J Cardiopulm Rehabil Prev2014; 34: 378–385.
15.
IsaksenKMunkPSValborglandT. Aerobic interval training in patients with heart failure and an implantable cardioverter defibrillator: a controlled study evaluating feasibility and effect. Eur J Prev Cardiol2015; 22: 296–303.
16.
ATS/ACCP. Statement on cardiopulmonary exercise testing. Am J Respir Crit Care Med2003; 167: 211–277.
17.
HansenJESueDYWassermanK. Predicted values for clinical exercise testing. Am Rev Respir Dis1984; 129: S49–S55.
18.
BeaverWLWassermanKWhippBJ. A new method for detecting anaerobic threshold by gas exchange. J Appl Physiol1986; 60: 2020–2027.
19.
NanasSNNanasJNSakellariouD. VE/Vco2 slope is associated with abnormal resting haemodynamics and is a predictor of long-term survival in chronic heart failure. Eur J Heart Fail2006; 8: 420–427.
20.
NanasSNanasJKassiotisC. Early recovery of oxygen kinetics after submaximal exercise test predicts functional capacity in patients with chronic heart failure. Eur J Heart Fail2001; 3: 685–692.
21.
GuazziMAdamsVConraadsV. EACPR/AHA Joint Scientific Statement. Clinical recommendations for cardiopulmonary exercise testing data assessment in specific patient populations. Eur Heart J2012; 33: 2917–2927.
22.
BaladyGJArenaRSietsemaK. Clinician’s guide to cardiopulmonary exercise testing in adults: a scientific statement from the American Heart Association. Circulation2010; 122: 191–225.
23.
CorraUGiordanoABosiminiE. Oscillatory ventilation during exercise in patients with chronic heart failure: clinical correlates and prognostic implications. Chest2002; 121: 1572–1580.
24.
KremserCBO’TooleMFLeffAR. Oscillatory hyperventilation in severe congestive heart failure secondary to idiopathic dilated cardiomyopathy or to ischemic cardiomyopathy. Am J Cardiol1987; 59: 900–905.
25.
LeiteJJMansurAJde FreitasHF. Periodic breathing during incremental exercise predicts mortality in patients with chronic heart failure evaluated for cardiac transplantation. J Am Coll Cardiol2003; 41: 2175–2181.
26.
CastroRRAntunes-CorreaLMUenoLM. Reversal of periodic breathing after aerobic training in heart failure. Eur Respir J2010; 35: 1409–1411.
27.
ZurekMCorraUPiepoliMF. Exercise training reverses exertional oscillatory ventilation in heart failure patients. Eur Respir J2012; 40: 1238–1244.
28.
YamauchiFAdachiHTomonoJI. Effect of a cardiac rehabilitation program on exercise oscillatory ventilation in Japanese patients with heart failure. Heart Vessels2016; 31: 1659–1668.
29.
PonikowskiPChuaTPAnkerSD. Peripheral chemoreceptor hypersensitivity: an ominous sign in patients with chronic heart failure. Circulation2001; 104: 544–549.
30.
Lorenzi-FilhoGAzevedoERParkerJD. Relationship of carbon dioxide tension in arterial blood to pulmonary wedge pressure in heart failure. Eur Respir J2002; 19: 37–40.
31.
RoditisPDimopoulosSSakellariouD. The effects of exercise training on the kinetics of oxygen uptake in patients with chronic heart failure. Eur J Cardiovasc Prev Rehabil2007; 14: 304–311.
32.
CornelisJTaeymansJHensW. Prognostic respiratory parameters in heart failure patients with and without exercise oscillatory ventilation – a systematic review and descriptive meta-analysis. Int J Cardiol2015; 182: 476–486.
33.
Colin-RamirezEOrea-TejedaACastillo-MartinezL. Malnutrition syndrome, but not body mass index, is associated to worse prognosis in heart failure patients. Clin Nutr2011; 30: 753–758.
34.
MaioranaAJNaylorLHExterkateA. The impact of exercise training on conduit artery wall thickness and remodeling in chronic heart failure patients. Hypertension2011; 57: 56–62.
35.
DelagardelleCFeiereisenPAutierP. Strength/endurance training versus endurance training in congestive heart failure. Med Sci Sports Exerc2002; 34: 1868–1872.
